Wait times at Worcester VA clinic among worst in nation

Monday

Aug 18, 2014 at 6:00 AMAug 18, 2014 at 12:28 PM

By Brad Petrishen TELEGRAM & GAZETTE STAFF

WORCESTER — The Veterans Affairs Central Western Massachusetts Healthcare System is working to shore up chronic deficiencies that have resulted in some of the longest wait times in the nation, many of which have been borne by veterans at its clinic in Worcester.

"The reality is, Worcester County has a very large metropolitan population that has historically been underserved," Roger Johnson, director of the VA Central Western Massachusetts, said Thursday. "We are very interested in expanding those services."

Based in Northampton, the VA Central Western Massachusetts provides primary, specialty and mental health care to more than 120,000 veterans in Worcester, Hampden, Berkshire, Franklin and Hampshire counties. It operates six facilities – a main hospital in the Leeds section of Northampton and smaller clinics in Worcester, Fitchburg, Springfield, Greenfield, Pittsfield.

According to data released Thursday, the average prospective wait time for a new patient looking for a primary care doctor in the Central Western system on Aug. 1 was 57 days. That's the fifth-longest wait time among the VA's 140 health care systems nationwide. The average wait time was 43 days.

New patients looking for specialists also had an average wait time of 57 days, 16th-longest in the country. The average was 46 days.

The system had 27,283 total appointments scheduled, 3,840 of which were scheduled beyond 30 days. That 14 percent rate is the 24th-worst in the country.

"It doesn't sound right," said state Sen. Harriette L. Chandler, D-Worcester. "These are people who fought to keep us free. Whatever they need, we should make sure they get."

The system's wait times — including wait times in Worcester – look troublesome when compared to systems such as the Bedford, Mass. VA, which sees new patients about 40 days sooner on average.

While VA officials said they do not break down wait times by clinic, they acknowledged that the Worcester clinic at 605 Lincoln St., both recently and historically, has struggled.

"Worcester seems to have been the biggest challenge," said the system's spokeswoman, Amy J. Gaskill.

She said the recent numbers are exacerbated by the recent unexpected departure of two primary care doctors at the Worcester clinic for personal reasons. Each doctor is responsible for up to 1,350 patients, she said.

"That's a lot of capacity there that was taken out of our system," she said.

With respect to specialized services, Ms. Gaskill said the problem is twofold. Not only does the clinic have a shortage of experts in fields such as optometry, but the pool of available doctors nationwide is shrinking, she said.

Mr. Johnson said that the Worcester clinic has since hired one new primary doctor and hopes to name a second soon. He said it's also in the midst of filling six new positions, including an optometrist, nurse, medical support assistant and dermatologist.

"This is the first full-time dermatologist we've ever hired," he said.

Mr. Johnson pointed to figures since June that show the wait times in the system gradually decreasing. On June 9, the average prospective wait time for a new patient to get an appointment with a primary care doctor was 72 days — 15 days longer than the Aug. 1 figure.

Despite the data, local lawmakers and veteran advocates say they haven't fielded many complaints from veterans.

Ms. Chandler and two other lawmakers, including veteran and state Rep. Harold P. Naughton Jr., D-Clinton, said they haven't received complaints from veterans about the clinic. Worcester Veterans Agent Karen Greenwood said she also hasn't heard complaints, though she noted many older veterans don't tend to complain about much.

Denis Leary, executive director of Veterans Inc., a Worcester-based organization that supports veterans, said he's been "thrilled" with the quality of care at the clinic.

"Many of our clients are homeless or almost homeless, and if you fall into that category, the VA up on Lincoln Street puts you at the front of the line," he said.

U.S. Rep. James P. McGovern, D-Worcester, said his office has fielded some complaints, but not many.

"By and large, the majority of vets who talk to us about the clinic in Worcester have nothing but praise for the doctors that work there," he said. "There are some really good people that work there that care very deeply about their patients and their mission."

Mr. McGovern acknowledged that the system, including the Worcester clinic, needs to improve.

"Can this facility do better? The answer is yes," he said, adding he believes the staffing additions are pointing it in the right direction.

Mr. McGovern also noted that the system is due for some added funding. As part of the $16.3 billion VA assistance bill signed by President Barack Obama Aug. 7, the Worcester clinic will get nearly $5 million.

Mr. Johnson said the plan is to use the funding to either expand its existing facility or get space somewhere else in Worcester.

The VA currently leases the building for $776,400 a year, according to Ms. Gaskill. Mr. Johnson said administrators would like to get at least 25 percent more space in the future to expand services and meet rising demand.

Though the number of veterans in the area overall is shrinking, hospital documents show the VA believes usage of the system by veterans will increase by 5 percent by 2019.

"We know (Worcester has) a large veteran population that we have to have as a primary focus for growth for the future," Mr. Johnson said.

He acknowledged that a "disproportionate" number of veterans who have been seeing lengthy wait times for care go to the Worcester clinic. Though recent turnover has been a part of the problem, it isn't the sole reason.

"I also think it's been a chronic issue of 30 years or 50 years of probably not as much service in the Worcester area as we should have had," he said.

Currently, the Worcester clinic receives $8.1 million annually in funding, less than 7.5 percent of the system's overall $110 million budget. It serves roughly 6,500 veterans annually — about 25 percent of the system's workload.

Asked whether he thought the funding percentage seemed low, Mr. Johnson said the figure is misleading. A number of costs associated with Worcester-area veterans aren't paid for by the Worcester clinic's budget, he said, since veterans go to other clinics within the system for a variety of ailments.

As administrators scramble to improve wait times, they've also been dealing with federal inspectors. The Central Western Massachusetts system is among 37 percent of VA facilities nationwide slated for further investigation by the federal government following an initial inspection several months ago.

Mr. Johnson said he's confident that the misleading scheduling practices that have happened elsewhere in the country did not take place here.

During the first inspection of the system, 30 employees who schedule appointments all said they never felt pressured into altering appointment dates, Mr. Johnson said

"Having said that, we had one staff member — I'm not even sure if they have scheduling privileges — who expressed to the team that their perception was that there was pressure," he said.

Mr. Johnson said a federal investigator has been scrutinizing the system "intensively" for weeks.

"To the best of my knowledge, they've never found anything to substantiate that allegation," he said.

Mr. Johnson said he couldn't say what title the employee who made the complaint held or at which facility he or she worked.

Controversy surrounding the national VA system exploded in April after media reports that as many as 40 veterans died while waiting for care at the VA in Phoenix.

At least 35 of those deaths have been confirmed by investigators who found that the VA there pressured employees to manipulate schedules and create secret lists of care in order to hide delays. The VA in 2010 implemented a goal of seeing all new patients within 14 days, a goal it has since deemed "unattainable."

Investigations into the scandal are ongoing, including criminal probes by the U.S. Department of Justice and FBI.

The VA Central Western Massachusetts has not been publicly accused of dishonest scheduling, nor has it faced allegations of poor quality of care like the VA clinic in Brockton.

Still, being ranked at the bottom of the barrel when it comes to wait times for patients isn't something that sits well with administrators.

"We definitely are disappointed in that, and we definitely know we have to work harder and move forward," Mr. Johnson said.

Ms. Chandler called the wait times "terrible," adding that they surprised her given the state's otherwise "impressive" reputation for veterans' services.

"If you're a veteran, this is probably the best state in the country to live in," she said. "But apparently not if you're a veteran and you have a health problem."

Contact Brad Petrishen at brad.petrishen@telegram.com. Follow him on Twitter @BPetrishenTG